Effect of informed consent for intravascular contrast material on the level of anxiety: how much information should be given?

PURPOSE: To compare the effect of two different informed consent forms on patients' anxiety level prior to intravenous contrast material (IVCM) injection. MATERIAL AND METHODS: Two different informed consent forms were randomly given to 265 consecutive patients referred for either intravenous pyelography or computed tomography requiring IVCM injections. Form 1 had brief information, including only the common risks and risk factors associated with IVCM, while Form 2 had more comprehensive information. Before being presented with the two different informed consent forms, 191 of the 265 patients filled out two other forms evaluating: 1: How they felt in that particular situation/moment (STAI-T); and 2: How they felt independently of the situation or condition at that moment (STAI-S). After the patients were informed, the STAI-T (measuring how they felt in that particular situation) was filled out once more to see if the anxiety level had changed. RESULTS: The anxiety level for 88 patients receiving Form 1 decreased after they were given the informed consent (P=0.033). However, among the 103 patients receiving Form 2, the anxiety level showed a significant increase (P=0.001) compared to the values obtained before Form 2 was given. CONCLUSION: These results indicate that informed consent, including brief information about the risk factors and potential adverse reactions of IVCM, reduces anxiety level, while detailed information before the procedure increases the anxiety level.

The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome.

AIM: The aim of study was to assess the usefulness of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. MATERIALS AND METHODS: Eighty-six patients with carpal tunnel syndrome confirmed by electromyography and 45 asymptomatic controls were included in the study and underwent high-resolution ultrasonography of the wrists. The cross-sectional area and flattening ratio at the level of the pisiform bone of the proximal carpal tunnel were measured. Data from the patient group and control group were compared to determine the statistical significance. The accuracy of the ultrasonographic diagnostic criteria for carpal tunnel syndrome was evaluated using receiver-operating characteristic (ROC) analysis. RESULTS: One hundred and forty-eight wrists of 86 patients with carpal tunnel syndrome and 76 wrists of 45 control patients were examined. All measurements showed significant differences between patients and controls. Increased cross-sectional area of the median nerve was the most predictive measurement of carpal tunnel syndrome. Using the ROC curve, a cut-off value of >10.5 mm2 at the level of pisiform bone provided a diagnostic sensitivity of 89% and specificity of 94.7% CONCLUSION: The ultrasonographic measurement of the median nerve cross-sectional area is a sensitive, specific and useful non-invasive method for the diagnosis of carpal tunnel syndrome.

Splenodiaphragmatic interposition of the descending colon.

We present a variation named splenodiaphragmatic or retrosplenic interposition of the colon in three patients aged 6, 70, and 71 years who suffered from different symptoms. The cases were found in 1,000 thoracoabdominal CT scans examined at the radiology clinic between 1999 and 2001. The upper part of descending colon was seen to be between the spleen and the left kidney on abdominal CT scans with contrast enema in the patient aged 71 years. In a 6 year-old child, part of the left colic flexure in the intestinal gas patterns was located between the left kidney and spleen, extending up to the diaphragm in the left hypochondrium on radiological examinations. The left colic flexure and the beginning of the descending colon were imaged on CT behind the spleen at the level of the 11th thoracic vertebra in the third patient aged 70 years. Hepatodiaphragmatic interposition of the colon has been reported previously in many patients; however, no detailed reports are available dealing with the interposition of the descending colon between the diaphragm and spleen. Three cases with retrosplenic colon variation were investigated in detail in the present study. The significance of retrosplenic colon is discussed. It is concluded that the identification of this anatomical variation could avoid unnecessary colon perforation during percutaneous nephrostomy, splenostomy, biopsy, or splenectomy.

Detection of vesico-ureteric reflux in children by colour-flow Doppler ultrasonography.

OBJECTIVES: To assess the findings of colour-flow Doppler ultrasonography (DUS) in the diagnosis of vesico-ureteric reflux (VUR), as an alternative to the primary diagnostic tool, voiding cysto-urethrography (VCUG). PATIENTS AND METHODS: Thirty-five children (aged 2-15 years) were examined for VUR by DUS and standard VCUG. All patients underwent DUS and VCUG within 48 h but the findings of the latter were not reported to the ultrasonographer. The DUS was undertaken using a colour Doppler real-time system; a positive ultrasonogram was defined by visualizing Doppler signals from the bladder to the ureter during the course of bladder filling. RESULTS: Of the 70 ureters assessed, 28 were refluxing on DUS and 29 on VCUG; there were two false-positive and three false-negative results. Comparing the two methods showed DUS to be 90% sensitive with a specificity of 93% for detecting VUR. Four patients underwent reimplantation during their treatment. DUS findings correlated well with standard VCUG in these patient as a method of follow-up. CONCLUSION: DUS can be used as an alternative to standard VCUG for screening and following VUR. In addition, DUS avoids the danger of exposure to ionizing radiation and the unpleasant catheterization that many of these children fear.

Use of color Doppler sonography in the evaluation of varicoceles.

Color flow Doppler sonography (CFDS) has been used to evaluate the blood flow to the testes, because of its ability to visualize small vessels with low flow. A total of 39 infertile men, 18 with clinical varicocele and 21 without, were examined using CFDS to assess the clinical usefulness of this technique. In patients with varicocele, venous diameter in the pampiniform plexus was greater than 2 mm, whereas those without varicocele showed diameters of less than 1.8 mm. Of 21 patients without varicocele on physical examination, 13 were found to have reflux by CFDS. According to clinical and CFDS findings, patients were divided into five groups: varicocele negative, suspicious subclinical varicocele, subclinical varicocele, manifest varicocele with Valsalva-induced reflux, and manifest varicocele. These data suggest that the CFDS technique is a simple, sensitive and noninvasive modality for the accurate diagnosis of varicocele.

Erectile dysfunction due to venous incompetence treated by dorsal vein ligation.

The authors describe 14 cases of erectile dysfunction. The sites of leakage were detected by duplex or colour flow Doppler sonography. Treatment by dorsal vein ligation resulted in fairly good early responses, however, at 4-month follow-up the great majority of patients returned to the original functional state.